[Show abstract][Hide abstract] ABSTRACT: Anti-N-methyl-D-aspartate receptor NMDA-R encephalitis is caused by antibodies against the NMDA-R and characterized by a severe encephalopathy with psychosis, epileptic seizures and autonomic disturbances. This disorder is often accompanied with malignancies, especially ovarian teratoma. Some patients' EEGs show a different pattern similar to the waveforms of premature infants and this pattern is specifically named as extreme delta brush (EDB). We report a 24-year-old female having anti-NMDA receptor encephalitis and EDB patern.
[Show abstract][Hide abstract] ABSTRACT: Objective: Poststroke depression was reported in approximately one third of the patients within the first two years of a cerebrovascular event. Depression is known to impair physical and cognitive recovery after stroke as well as increasing the morbidity and mortality. However, no definite consensus has been reached regarding the best treatment option. The aim of this open-label study was to determine the efficacy and safety of the selective serotonin reuptake inhibitor (SSRI) escitalopram in post-stroke depression treatment. Method: Patients showing symptoms of depression within 6 months of a cerebrovascular event were included in this study. Patients with Hamilton depression (HAM-D) score of <13, mini mental standardized test score of <23, schizophrenia, behavioral disorders, substance abuse, history of alcoholism, current use of antidepressants, and history of stroke or major depression within the last one year were not included. All patients were administered escitalopram 10 mg/day for 3 months. Primary end-point was the improvement in HAM-D scores. Additionally, stroke severity and extent of functional impairment was assessed by NIH stroke scale, Barthel index and Rankin scale; side effects were followed; the relationship between HAM-D scores and sociodemographic variables and stroke localization was investigated. Results: A total of 35 patients (21 female, 14 male; mean age, 67± 6) were included. Depression was diagnosed 3±1.2 months after the stroke. Following the initiation of treatment, HAM-D scores decreased significantly in all visits (days 15, 30, 45, and 90). The mean HAM-D score decreased from 27.5±4.7 to 4.65±2.47 at day 90 (p <0.0001). No significant correlation was found between HAM-D scores and cerebrovascular event localization, age, smoking, history of depression or panic disorder, history of psychiatric medication use and history of depression in the family. Escitalopram was well tolerated. A total of 9 patients (26%) reported nausea, anxiety, drowsiness and dyspepsia on the day 15. No other side effects were reported on the following visits (except for one patient with dyspepsia complaints on the day 30). Conclusions: In this open-label study escitalopram was found to be safe and effective for use in post-stroke depression patients. Larger, placebo controlled, randomized double blind studies are needed to better evaluate the efficacy of escitalopram. Response to escitalopram treatment should also be investigated in more severe stroke patients suffering physical and cognitive function loss.
No preview · Article · Dec 2010 · European Psychiatry
[Show abstract][Hide abstract] ABSTRACT: In this study, we aimed to evaluate motor cortical excitability changes in patients with juvenile myoclonic epilepsy (JME) and their asymptomatic siblings (AS) using single-pulse transcranial magnetic stimulation (spTMS). 21 patients with JME and their 21 AS were compared to 20 healthy controls. All of JME patients were receiving antiepileptic therapy and their seizures were well controlled. Firstly, standard EEG examinations and then TMS studies were performed. Resting motor threshold (RMT), motor evoked potential (MEP) amplitudes, the durations of central motor conduction time (CMCT) and cortical silent period (CSP) were measured. After TMS studies, EEG recordings were repeated in an hour to evaluate any effect of TMS study on EEG. There were no significant differences between the first and second EEG recordings. No seizures were recorded during and after the TMS study. RMT was found higher in JME patients than AS and normal controls. There were no significant differences between cortical MEP amplitudes and MEP amplitude/CMAP (compound muscle action potential) amplitude ratio in all three groups. CMCT duration was shorter in JME patients than AS. CSP durations of JME patients were found to be longer than controls. In AS, CSP durations were also found to be longer than controls but this difference was not found statistically significant. Our results suggested that although high MT may be related to antiepileptic therapy, the prolongation of CSP duration may reflect impairment of supraspinal and/or intracortical inhibitory mechanism in JME. To eliminate the drug effect, further studies are needed in newly diagnosed JME patients without medication and large series of their asymptomatic siblings.
[Show abstract][Hide abstract] ABSTRACT: We describe the magnetic resonance imaging (MRI) findings in two patients admitted to our institution with neuropsychiatric symptoms and severe abdominal pain diagnosed as acute intermittent porphyria (AIP). MRI revealed multiple lesions which regressed following treatment. We suggest reversible cerebral vasospasm underlies the MRI abnormalities and the cerebral symptoms in porphyria.
[Show abstract][Hide abstract] ABSTRACT: Purpose: Studies investigating the role of nitric oxide (NO) in ischemic cerebral process by measuring the level of serum and cerebrospinal fluid nitric oxide-metabolites (NO-m) (nitrites and nitrates) in acute term and comparing this values with predetermined parameters were reported different results and had lead to different opinions. NO has been suggested to play an important role in the pathophysiology of acute ischemic strokes in previous studies, in this study we studied the relation between acute period NO serum levels in patients with ischemic strokes and the sub types grouped according to etiology and lesion size. Material and Method: 40 patients with ischemic stroke and a control group of 20 healty subject were included in this study. All the patients in the study group applied to the hospital within the first 24 hours of the onset of symptoms. Patients were classified by TOAST classification system according to the lesion sizes that were measured from Computorised Tomography images in the first 48-72 hours. Serum NO metabolite levels were measured within the first 24 hours in all patients and control group Results: We found higher NO-m values in ischemic stroke group compared with control group. We didn't find any significant relationship between NO-m levels, stroke subtypes and lesion volumes. Conclusions: Previous reports concluded that there were a relationship between NO-m levels and lesion volume in ischemic stroke. Our limited case and control number may be responsible for the statistically negative results. Future larger studies are needed to investigate the exact role of NO on cerebral ischemic process.
No preview · Article · Apr 2006 · Turk Serebrovaskuler Hastaliklar Dergisi
[Show abstract][Hide abstract] ABSTRACT: In this article, we report a caes of Moyamoya disease in a 38 year old woman with characteristic clinical and radiological features of recurrent transient ischemic attacks within three yaers.